What Are Forehead Lines (Frontalis Rhytids)?
Forehead lines, or frontalis rhytids, are horizontal creases across the forehead that form when the frontalis, the main muscle that lifts the eyebrows, contracts. "Rhytid" is the medical term for a wrinkle. Forehead lines are dynamic lines, which means muscle movement causes them. After years of repeated movement, they can become permanent.
Forehead lines are a normal part of skin aging, not a disease. Treatment is cosmetic and optional.
Forehead Lines at a Glance
| Also called | Frontalis rhytids, horizontal forehead lines, forehead wrinkles |
|---|---|
| Cause | Repeated contraction of the frontalis muscle, plus natural skin aging, sun exposure, smoking and genetics |
| Who gets them | Anyone, with age. Genes, sun exposure and smoking affect how early they appear. |
| Is it serious? | Usually not. Wrinkles are rarely a concern unless they appear at an early age. |
| Diagnosis | A visual exam of the forehead at rest and while raising the eyebrows |
| Treatment | Botulinum toxin injections, fillers, resurfacing and creams such as tretinoin |
| FDA-approved injections | Botox Cosmetic and Xeomin, for moderate to severe forehead lines in adults |
| How long injections last | About 3 to 4 months, sometimes longer |
What Causes Forehead Lines?
Forehead lines are caused by years of raising the eyebrows, which repeatedly contracts the frontalis muscle. Repeating the same expression for many years makes the lines permanent. Other factors add to this:
- Natural aging: skin becomes thinner and drier, and the fat beneath it shrinks. Genes largely control the timing.
- Sun exposure: frequent sun exposure causes early wrinkles, and every tan, including from tanning beds, ages skin early.
- Smoking: greatly speeds up skin aging and causes wrinkles.
How Are Forehead Lines Evaluated?
Forehead lines are evaluated with an exam of the face. Expert consensus recommends examining the face at rest and during movement, both by looking and by touch. Before injections, the clinician reviews your medicines, supplements, past surgeries and cosmetic treatments. You'll also be asked whether you are pregnant or plan to become pregnant.
How Are Forehead Lines Treated?
Forehead lines can be treated with botulinum toxin injections, which temporarily relax the targeted muscle so lines diminish.
Botulinum Toxin Injections
- FDA status: Botox Cosmetic and Xeomin are both FDA approved for moderate to severe forehead lines in adults.
- How it's given: small injections into the forehead muscle, with the frown-line area treated at the same time to lower the risk of a droopy brow.
- Results: most people see results within 3 to 7 days. In two main Botox Cosmetic trials, 46% to 61% of treated adults improved at least two grades on a four-point wrinkle scale at 30 days, versus 0% to 1% on placebo.
- Aftercare: most people return to normal activities right away. Don't rub the area, and wait two hours before strenuous exercise.
Other Options
- Creams: tretinoin (Retin-A) or creams with alpha-hydroxy acids, such as glycolic acid
- Resurfacing: chemical peels, laser resurfacing or dermabrasion, which work well for early wrinkles
- Fillers: may be used for forehead contouring. Fillers and wrinkle-relaxing injections can be used alone or together.
Risks and Who Should Avoid Injections
Side effects are usually mild and temporary, such as swelling, redness, soreness and bruising. On the Botox Cosmetic label, the most common reactions after forehead treatment were headache (9%) and brow droop (2%). The label also has a boxed warning that the toxin's effect can spread and cause swallowing or breathing problems.
Injections aren't right for people allergic to any botulinum toxin product or who have an infection at the injection site. Tell your provider if you are pregnant; it isn't known whether treatment can harm an unborn baby.
Can You Prevent Forehead Lines?
You can't fully prevent forehead lines, but you can slow how quickly they form:
- Use a broad-spectrum, water-resistant sunscreen with SPF 30 or higher every day. In a 4.5-year trial, adults who used sunscreen daily showed no detectable increase in skin aging.
- Wear a wide-brimmed hat and UV-protective sunglasses, which can help reduce lines caused by squinting.
- Don't smoke, and avoid tanning beds.
When Should You See a Clinician About Forehead Lines?
See a clinician about forehead lines if your skin seems to be wrinkling faster than normal for your age, or if you'd like to discuss cosmetic treatment. After an injection, get help right away for trouble swallowing, speaking or breathing.
Forehead Lines vs. Frown Lines and Crow's Feet
Forehead lines differ from frown lines and crow's feet in where they appear and which muscle causes them.
| Where | Muscle involved | Botox Cosmetic dose on label | |
|---|---|---|---|
| Forehead lines | Horizontal lines across the forehead | Frontalis, which raises the brows | 20 Units, given with 20 Units for frown lines |
| Frown (glabellar) lines | Between the eyebrows | Corrugator and procerus | 20 Units |
| Crow's feet (lateral canthal lines) | At the sides of the eyes | Orbicularis oculi | 24 Units |
Forehead Lines at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a provider evaluates your forehead lines and health history. Based on that evaluation, your provider recommends treatment at GENEVA or a referral to a specialist.
You can read about wrinkle-relaxing injections and dermal fillers before your visit. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
- Dynamic Wrinkles
- Glabellar Lines
- Crow's Feet
- Botulinum Toxin
- Botox
- Xeomin
- Wrinkle Prevention
- Aging Skin
Forehead Lines FAQs
What causes forehead lines?
Forehead lines are caused by years of raising the eyebrows, which repeatedly contracts the frontalis muscle, combined with natural skin aging. As skin ages, it becomes thinner and drier, and the fat beneath it shrinks. Sun exposure, tanning and smoking make wrinkles form sooner, and genes largely control when aging changes begin. After many years of the same expression, the lines become permanent. Daily sunscreen and not smoking help slow them.
Are forehead lines a sign of a health problem?
Forehead lines are usually not a sign of a health problem. They are a normal part of aging, and wrinkles are rarely a cause for concern unless they appear at an early age. Common causes of wrinkles include family history, normal aging, smoking and sun exposure. Frequent sun exposure causes early wrinkles, and cigarette smoke can also make skin wrinkle sooner. Talk to a clinician if your skin seems to be wrinkling faster than normal for your age. At the visit, your provider examines your skin and asks whether any spot has become painful or bleeds.
How long does Botox last for forehead lines?
Botox for forehead lines usually lasts about 3 to 4 months, and sometimes longer. Most people see results within 3 to 7 days. In the Botox Cosmetic trials, the response rate for forehead lines was similar across three treatment cycles over one year. The American Academy of Dermatology notes that with repeat treatment, the muscle may thin, which can lead to longer-lasting results. You can have another treatment when the lines return.
Do forehead lines go away on their own?
No, forehead lines don't go away on their own, but treatment can soften them. Botulinum toxin injections relax the muscle for about 3 to 4 months at a time. Tretinoin or alpha-hydroxy acid creams, chemical peels, laser resurfacing and dermabrasion can improve early wrinkles. Fillers may also be used to contour the forehead, alone or with injections. A clinician can tell you which approach fits the depth of your lines and your health.
What is the difference between forehead lines and frown lines?
Forehead lines run horizontally across the forehead, while frown lines (glabellar lines) form between the eyebrows. Forehead lines come from the frontalis muscle, the main muscle that lifts the brows. Frown lines are linked to the corrugator and procerus muscles. The Botox Cosmetic label calls for treating forehead lines together with frown lines, 20 Units in each area, to lower the risk of a droopy brow. Crow's feet, at the sides of the eyes, are a third type of upper-face line.
How can I prevent forehead lines?
You can't fully prevent forehead lines, but daily sun protection and not smoking slow how fast they form. The American Academy of Dermatology recommends a broad-spectrum, water-resistant sunscreen with SPF 30 or higher every day, plus a wide-brimmed hat and UV-protective sunglasses, which help reduce lines caused by squinting. In a 4.5-year trial in Australia, adults who used sunscreen daily showed no detectable increase in skin aging. Avoid tanning beds. People who already have lines can still benefit from these changes.
Can a primary care provider treat forehead lines?
Yes, a primary care provider can evaluate forehead lines and discuss treatment options. Forehead lines are assessed with a visual exam at rest and while you raise your brows, plus a review of your medicines and pregnancy plans. At GENEVA in Alpharetta, a provider evaluates your lines and health history, then recommends treatment at GENEVA or a referral to a specialist. Injections aren't recommended if you are allergic to botulinum toxin or have an infection at the injection site.